Understanding the rise in drug mortality rates among black Americans in the 2010s: Associations with county-level construction job shares in the United States.

Objective: In 2020, Black Americans became one of the racial/ethnic groups with the highest drug mortality rates, yet factors driving this trend remain unclear. Given the increasing participation of Black workforce in the construction sector during the 2010s-a sector that typically offers livable wages without requiring college degrees-this study examines whether changes in the concentration of local construction sector jobs are associated with variations in drug mortality among Black Americans across U.S. counties. Methods: Data were drawn from the National Center for Health Statistics' Multiple Cause of Death file, linked with construction job shares, drug supply, and sociodemographic characteristics from other administrative data sources. After examining county characteristics based on changes in construction job shares from 2010-2013 to 2018-2021, first-difference regression models assessed the effects of construction job shares on drug mortality rates among overall and working-aged Black populations. Results: A 1 percentage point increase in construction job shares was associated with a reduction of 6.67 drug-related deaths per 100,000 among Black residents, with a larger effect (10.32 deaths) among working-aged individuals. Over the study period, this translates to a shift in drug mortality rates from an increase of 38.2 deaths per 100,000 in counties with a 0.5 percentage point decline in construction job shares to a decrease of 1.8 deaths per 100,000 in counties with a 5.5 percentage point increase. Conclusions: Growing employment opportunities in the construction sector may provide population-level protection against drug mortality for Black Americans, particularly among the working-aged population.